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Anaesthesiology

Introduction
Welcome to the Department of Anaesthesiology, Pain medicine and Surgical Intensive Care (DAPS) at BLK Super Speciality Hospital. Our mission is to deliver state-of-the art, excellent anaesthesia services, pain management and intensive care in the perioperative setting. The department is committed to place the interests of the patients as its paramount concern. The adoption of newer technology with a human touch has propelled us to reach greater heights.

Department Highlights
Our work is just not confined to the state of art-ultra modern 18 Operation Theatres (OTs), but also beyond it. It extends from the Preanaesthesia clinic (PAC) to Post Anaesthesia Care Units (PACU) and 11 bedded Surgical Intensive Care Unit (SICU) where patients are closely followed by our team. The OT complex and Surgical Intensive Care Unit (SICU) are located on 2nd floor of the hospital. We provide clinical anaesthesia services and critical care management of surgical patients 24 hours a day. The surgical specialities to which the department provides anaesthesia services are general surgery, orthopaedics, obstetric and gynaecology, E.N.T., Ophthalmics, paediatric surgery, urology, plastic surgery, gastroenterology, cardiac surgery, surgical oncology and neurosurgery. We have a separate OT near casualty for minor emergency surgical procedures, a seperate OT (on 4th floor of the hospital) for handling emergency obstetric cases and another OT (on 7th floor) to cater to cases pertaining to the procedures of In-vitro fertilisation (IVF).

We live in challenging times and fueled by the success of our department and hospital we are now building and expanding our clinical work to teach and train budding anaesthesiologists. In near future we will be recruiting our first batch of DNB students.

Although surgery and the perioperative period can be a stressful experience, We at DAPS, BLKMH, help you in coping with this stress and transform this period into a wonderful experience. We try to ensure that you have a smooth recovery and that this is the beginning of a period of good health and wellness for you. We are firm believers of the fact that apart from the skill of the surgeon, the meticulous anaesthesia technique, one thing which is most important is the attitude of the patient entering surgery.

“Through my research, I became convinced that beliefs have physical repercussions ...That the human spirit is relevant, indeed influential, in the treatment and prevention of illness. In my thirty years of practicing medicine, I’ve found no healing force more impressive or more universally accessible than the power of the individual to care for and cure him or herself.”

Herbert Benson, “Timeless Healing”

We at the department of Anaesthesiology, Pain Medicine and Surgical Intensive Care, BLKMH try to bring a positive change in the attitude and perception of the patients entering surgery.

Our mission is to deliver state-of-the-art, excellent anaesthesia services, pain management and intensive care in the perioperative setting. A work environment of mutual trust, understanding, appreciation and respect between the surgeons and anaesthesiologists is encouraged.

Services and Treatments Offered

Specialized Services
The department is organised into the following functional sub-units:-

(a) Anaesthesia outside the OT area

We are now as active outside as within the operating room, being a predominant resource in the intensive care, pain management, emergency and prehospital care. What has evolved is the “peripatetic (a person who walks from place to place) anaesthesiologist” – an appropriate term applied to anaesthesiologists providing care in offsite locations. The demand for anaesthesia care outside the operating room continues to grow, driven by trends in advanced diagnostic techniques and the financial advantages of providing care out of the hospital setting. Within the next decade, it is estimated that 20-40 percent of anaesthetic cases may be performed outside the operating rooms as per western data and around 5-10% in India.

In future, anaesthesiologist will be spending half the work in time in areas other than the operating room.

The sites where we work outside the OT area can be categorised into:

  • The site not designed for the administration of anaesthesia e.g. emergency room for cardioversion, burns dressing rooms, psychiatric wards (ECT).
  • Areas where equipment is fixed as neuroradiology suite for CT, MRI, radiotherapy.
  • Specially built operating rooms outside the complex e.g. day care surgery, IVF OTs.
  • Specialised diagnostic suites e.g. endoscopy rooms.
  • Resuscitation and emergency rooms.
  • Pain clinic and pain relief procedures room.
  • Domiciliary care (in developmental stage at BLKMH). 

(b) Modular OTs

A pre-engineered integrated approach to the construction and co-ordination of operating rooms is adopted. Our operating rooms are of highest quality and standards. The modules are built of steel with sterile coatings to provide anti-bacterial, anti-algal and anti-fungal features for long and safe run. The OTs are designed to have smooth surfaces with no visible joints. The absence of sharp edges prevent any chances of accumulation of stagnant air or build up of contamination. The inner wall panels are constructed to withstand strong impacts, such as from the bombardment of trolleys. The wall-mounted equipments are flush mounted and sealed into theatre wall by means of sterile jointing system.

There is a provision of light integrated planair system to reduce airborne bacteria in an operation theatre. The unidirectional vertical laminar flow system delivers the clean filtered optimum air into the area in which operation is to be performed and sterile equipments are exposed. The system of integral lightning provides an illumination level in excess of 1500-lux at the wound site and electronic stepless dimming down to 3%, without flicker. 

The Cascade pressure stabilisers are a range of multi-bladed units especially designed to control room air pressures. Suitably sized air relief pressure stabiliser is strategically placed and enables differential room pressures to be maintained and ensure that when doors are opened between clean and dirty areas there is sufficient air flow through the open door to prevent cross contamination.

The scrub stations are specially designed to ensure that the OT staff adhere to highest standards of sterility. They are made up of stainless steel with both manual and automatic operations available. A thermostatically controlled mixing valve automatically maintains water temperature, not to exceed 46 degree Celsius.

(c) The Perioperative Period

Preanaesthesia Evaluation

On the day of your preanaesthetic evaluation you will be asked to come to Room no. 117 (OPD-3) at the first floor of BLKMH.

For us, your visit to the clinic is to know about you and your medical history to allow us to make the best anaesthesia plan for you to have the best experience possible. There are special features of a medical history important to anaesthesiologists, and this will also allow you the time to ask questions you may have and receive teaching about your upcoming anaesthetic. In this meeting feel free to talk over any worries you have about your surgery. We appreciate if you bring a family member or a friend with you for this visit. We will discuss about the possible anaesthetic methods, their benefits, risks and your preferences. We can then decide together what would be best for you.

During this visit you may have a blood sample taken for tests. More tests like ECG, X-ray and pulmonary function tests will be done if required. If you are going to have your hip or knee joint replaced you may be asked to visit a physiotherapist. Sometimes we send you to see a medical physician or a cardiologist to make sure that you are ready to have your surgery. If you are worried about anaesthesia, this is the time to talk about it.

You will then be instructed by the surgeon to get admitted to the hospital on the morning of the surgery or an evening before.

Here are a few things you may be asked to do to get ready for surgery

  • Bath or shower before your surgery will clean your skin and reduce the risk of infection.
  • Avoid/ remove nail polishes, mehndi on the hands as they interfere with our monitoring gadgets.
  • Avoid use of body lotions/ creams as they might interfere with ECG electrodes/ dressing pads.
  • You will be given a hospital gown to wear. You need to remove all your undergarments.
  • If regional anaesthesia is planned you can bring your –MP3 or CD player to the OT.
  • You cannot wear glasses, hearing aids and dentures to go to the OT. You will be instructed when to remove them.
  • Jewellery should be removed before coming to the OT. If you cannot remove for some reasons, talk to your anaesthesiologist. It will be covered with a tape instead.
  • You must follow the instructions about fasting. You will be given specific orders about-Nothing to eat/drink-fasting (NPO ORDERS). If there is any food or liquid in your stomach, during your anaesthesia, it could come up into your throat and go into your lungs. This could cause choking, or serious damage to your lungs.
  • Take morning dose of medicines like antihypertensives, anti-anginals etc. with little bit of water as instructed.
  • Stay calm and cool

When you are Called for Surgery

When it is time for your surgery nursing staff of the ward will accompany you to the OT. A family member or a friend can also accompany you to the entrance of the OT complex. During the period of surgery your relatives can wait either in your room or in the Attendant Waiting lounge situated next to the OT complex on the second floor of the hospital.

Most people go to the theatre on the bed. You may choose to walk but that depends on your general health and whether you have had a premedication drug.

The Operation Theatre Complex

The operation theatre complex includes a reception/ registration desk, preanaesthetic room, operation theatres, recovery room. The drug store and sterilization department are also there in the same complex which makes availability of things easier, faster and in a coordinated manner.

This complex will be different from other hospital departments – more cold, less crowd and brightly lit. Theatre staff normally wear coloured kurtas and pyjamas and paper hats and mask which is different from the ward staff.

The Preanaesthesia Room

You will then be asked to get into the OT trolley. The theatre staff will check your identity, your name and MRD No. And will ask you about other relevant details. The nursing staff of the ward will give a detailed over to the preanaesthesia room staff.

The Operating room

The anaesthesiologist in-charge of your case will visit you in the preoperative room. He/she will confirm your fasting status and will again scan your file. He will reconfirm any known drug allergy which you might be having. You will then be shifted to OT.

Monitoring
To monitor you during the surgery, your anaesthesiologist will attach you to machines to monitor

  • Your Heart: sticky patches (electrodes)will be attached on your chest. (ECG or electrocardiogram)
  • Your Blood Pressure: A blood pressure cuff will be placed on your arm.
  • The oxygen level in your blood: A clip will be placed on your finger (Pulse oximeter)


More monitoring will be needed for major and long duration surgeries. These devices will however be put once you go off to sleep.

IV canulation

We need to give you medications and saline into a vein. A needle will be used to put a thin plastic tube (canula) into a vein in the back of your hand or arm. Sometimes, if your veins are thin, more than one attempt may have to be taken to insert the canula. If need be you will be given blood through this vein.

General Anaesthesia

During general anaesthesia, at times depending upon your condition, medical illness and age, you will be requested to breathe through a mask kept on your face. You just have to take deep breaths at this time. We will be just giving you oxygen at this time, the concentration of it will be much more than we normally breathe.

Spinal/ Epidural Blocks

Spinals or epidurals, the most common regional blocks, are used for operations on the lower half of your body. There is no need to make you unconscious after a spinal/epidural. You will breathe on your own, and will be able to speak. You will not feel any pain during surgery.

Spinals are single injections which take only a few minutes to have their effects and last for 3-4 hours whereas Epidurals take a little longer to perform but can be used to relieve pain for 2-3 days after surgery.

We will give you local anaesthesia to reduce the discomfort of the injection for the block. You need to help us at this moment. You will be instructed on how to make your position at this time. If the positioning is not proper, it can take more than one attempt to get the needle at the right place. Your cooperation will help us a great deal at this moment. Once the needle is at the right place and appropriate amount of drug has been given, you will notice a warm tingling feeling with the onset of block. You will feel as if the area anaesthetized is no longer part of your body. The surgeon may start the cleaning and draping of the surgical area then, but will not start the surgery till the numbness is complete and you are comfortable.

These blocks are generally given when you are conscious. Many people are worried that they will be fully awake, and able to know everything that is going in the operating room if they choose a spinal or a nerve block. Sedation may be used with these blocks to make you relaxed during the surgery. You may close your eyes and have a nap! In some major cases it is appropriate to combine regional anaesthesia with general anaesthesia to provide pain relief during and after the surgery. This will also help you in recovery.

Nerve Block: A nerve block is when a drug is given next to the nerves to make the area where you are having surgery numb. e.g. if you are having surgery on your hand, the nerve blocks can be used so that you will not be able to feel your hand during the surgery. A nerve block will control pain in a limited area of the body. For a few hours after the surgery you might not be able to move your blocked area.

Post Operative Period

When the surgeon has finished the surgery, the anaesthesia gases and drugs which we are giving will be withdrawn and reversal of anaesthesia using drugs will be done.

After your surgery is over, your anaesthesiologist will take you to the Post-Anaesthesia Care Unit (PACU). If the operation is a simple one you may already be wide-awake, or if your surgery is more complex you could still be sleeping. In the PACU a nurse is assigned to your care and monitors for vital signs are attached. The nurse will continue to assess your well-being by checking vital signs such as blood pressure and heart rate, your level of wakefulness, and your pain control requirements.

During this period your family will be able to come and see you. For patients having surgery on the second floor, families are asked to wait in the Attendant lounge on the same hospital floor as the operating rooms, and PACU. The family can also be contacted on the mobile number which they give at the time of admission if they are not in the lounge, for any reasons. The volunteer staff will escort your family to the PACU to visit you.

Once you have recovered from anaesthesia and the medical staff has assessed that your condition is stable, and after consultation with anaesthesiologist in- charge of your case, you will be discharged from the PACU to your room. Nursing staff will come from ward to escort you to your room. Here family members can visit you as per the hospital policies and timings.

If you are having day care surgery, the check-in room is on the second floor only, just near to the OT complex and the attendant lounge. After surgery, these patients after being discharged from PACU are moved on to this area again. Your family can visit as you recover. Visiting is at the discretion of the PACU nursing staff, and only one family member is allowed in at a time.

(d) Pain Medicine

It was once thought that severe pain after surgery was something to be endured. But we now know that this is no longer true. Today Acute pain services bridges the gap between physicians, nurses and patients to coordinate pain management. At BLKMH, we are interested in providing the safest and the best pain relief for all patients after surgery. To ensure this we have an Acute pain Service (APS) to provide specialized pain treatment to any patient who require it. Ask your nurse or surgeon if you wish to contact the Acute Pain Service.

The deleterious effects of unrelieved acute pain are well recognized. These effects are psychological and physiological. Unrelieved acute pain may predispose to the development of chronic pain. The provision of acute pain relief helps reduce hospital stay, promotes recovery and reduces the development of chronic pain syndromes. After the surgery you will get better faster. With less pain you can walk sooner and do breathing exercises better.

We understand the importance of postoperative pain relief and the improvement in function that accompanies it. We recognize the large degree of variability among surgical patients with regard to the amount of pain experienced and the amount of analgesic medication needed to adequately control it. As a matter of fact, we have certain standardised institutional guidelines and protocols for ordering, administering and discontinuing analgesic therapy.

The ultimate target of our Department of Anaesthesiology, Pain medicine and Surgical Intensive Care at BLKMH is an active quality assurance program directed at maintaining high-quality care of our patients while minimizing complications.

Acute Pain Service

The hospital has a formal acute pain service that provides specialized and invasive methods of pain relief to patients after surgery and all other acute and acute on chronic pain conditions. It is available 24 X 7. The doctor can be contacted on mobile number 931077622. The Department also specializes in providing pain relief care in difficult acute pain problems such as management of patients already taking strong analgesics for cancer and chronic non-malignant pain, and those who are problem drug users. A standard multimodal approach to pain management utilising non-drug and drug interventions together is followed. Paediatric, geriatric, and day care patients are given utmost priority and are managed with an extra effort. There is also a provision of continuity of pain control after discharge.

Apart from offering postoperative pain services we also offer management of other types of acute pain like chest trauma, burns etc. We are uniquely qualified because of our knowledge of the neurophysiology, pathophysiology, pharmacology, and anatomic pathways involved in the modulation of acute pain.

Treatment options available for acute pain range from simple medication to more complex interventions such as neural blockade, neuraxial (epidural and intrathecal infusions and Patient –controlled analgesia (PCA). A variety of these methods may be used together to get the best result. The best method for you and your operation will be discussed with you.the effectiveness of your pain relief will be regularly assessed and if necessary adjusted, added or changed to make it the best and safest to you. It is reassuring to know that drugs used for pain control are extremely safe and there is hardly any chance to become addicted to them. The advantages gained by good pain control far outweigh these small risks.

Every patient enrolled in APS is assessed at least once a day by a consultant anaesthesiologist. ‘Pain rounds’ are taken by resident anaesthesiologists at least twice a day and as and when required. Any problems/queries are sorted out on the rounds. Although good quality analgesia is a worthwhile humanitarian and ethical goal in its own right, however, it is only the means to an end: the improvement of surgical outcome.

The Pain Clinic

Our Pain Clinic is located in Room no. 117 in OPD-3 block, first floor. Patients with chronic pain are generally seen here. The components of chronic pain management are cancer pain (treated in association with oncologists) and chronic non-malignant pain. The most widespread chronic pain conditions are- low back pain, neck pain, painful joints (arthritis), headache (including migraine). They are so common today that they are often seen as unavoidable part of life. There is no nobility in suffering from pain, when relief from pain is possible. Other pain conditions are: - recurrent cancer pain, Herpes zoster pain, Trigeminal neuralgia and other oro facial pains , Painful Diabetic neuropathy, fibromyalgia, Neuropathic pain, complex regional pain syndromes (CRPS), pain after amputation of the limbs, Chronic persistent surgical pain (CPSP), Post-trauma pain, Chronic pelvic pain, Genito-urinary pain, nerve entrapments etc.

(e) Surgical Intensive Care Unit

The state of art SICU comprising of 11 beds, boasts of up-to-date monitoring equipment and ventilators which provide a strong back-up for the surgical units. Our Surgical ICU admits critically ill patients that have undergone major vascular, neurosurgical, thoracic, orthopaedic, general surgical and onco-surgical procedures, as well as patients who have suffered from trauma and severe infections. We also admit critically ill cancer patients. These patients have neutropenia, chemotherapy related complications, sepsis, ARDS, and multi-organ failure etc.

The surgical ICU is staffed 24 hrs a day with attending intensivists from the anaesthesia department. The unit is equipped with state of art amenities to provide variety of critical care services including airway management, mechanical ventilation, circulatory support including specialised haemodynamic monitoring, renal support with provision of dialysis, enteral /parenteral nutrition, blood component therapy, pain relief and other supportive measures.

A lot of importance is given to the multidisciplinary approach to intensive care management. Other members involved include respiratory therapists, specialised nurses, physiotherapists, dieticians, paramedical and technical staff. The SICU also takes consults from other super-specialised services as and when needed. 

Our critical care doctors staff other hospital units as well, including:

  • Post Anaesthesia Care Unit (PACU), which stabilizes patients immediately following surgical procedures requiring general anaesthesia.
  • Airway Management Service, staffed by anaesthesia residents alongwith critical care fellows and staff, is available 24 hours a day to manage airway emergencies throughout the hospital. The anaesthesia duty doctor is part of code blue team.

(f) Labour Analgesia

Goal: Delivery of healthy infant into the arms of conscious and pain free mother.

Who perform the procedure?
Anaethesiologist are the specialist doctors having knowledge and experience in managing all types of pain relief including pain during vaginal delivery.

What you are supposed to inform to the Anaethesiologist?

  • If you have any infection in the lower back area
  • If you are allergic to any drug
  • If you have any bleeding tendency
  • If you are on any blood thinner medicine
  • If you are on any drug
  • If you have any medical ailments

What are the Pre Procedure precautions?

  • Preferably not to take solid food once you are in labour.
  • Sign the relevant consent form.
  • Clear all your queries before procedure.

Procedure: Epidural/CSE:
Anaesthesiologist cleans the back in the sitting/ lying down position, a very small injection of local anaethetic drug will be given at the lower back to make the area numb, followed by pain free insertion of a hollow needle in the space between the spine, after confirming the epidural space very thin soft malleable epidural catheter is passed through the needle and the needle is removed. After giving the test dose, Anaesthesiologist gives one dose of drug directly around the spinal cord or occasionally into the CSF, which gives almost immediate pain relief and then a continuous infusion is started for pain relief.

What are the Advantages?

  • Improves Utero placental circulation
  • It coverts the incoordinate uterine movement into more coordinated movement thus helping in expulsion of baby
  • No muscle weakness with ability to participitate during active labour
  • Prevent maternal hyperventilation therby ensuring adequate oxygen delivery to the fetus
  • Faster cervical dilatation
  • Provides rapid and superior pain lief
  • It provides anaesthesia for episiotomy or forceps delivery

What are the common side effects?

  • Headache
  • Transient paraesthesia
  • Hypotension 

 

a passion for healing...